BMC Anesthesiology最新文献

{"title":"Impact of perioperative dexmedetomidine on long-term outcomes in older patients following cardiac surgery: follow-up of a randomized trial.","authors":"Hong Hong, Xue Li, Jing Yang, Yan Zhang, Guang-Yu Liu, Fu-Xia Yan, Dong-Xin Wang","doi":"10.1186/s12871-025-02963-w","DOIUrl":"10.1186/s12871-025-02963-w","url":null,"abstract":"<p><strong>Background: </strong>Perioperative dexmedetomidine is reported to reduce complications and even in-hospital mortality after cardiac surgery. We therefore tested the hypothesis that perioperative dexmedetomidine may improve long-term outcomes after cardiac surgery.</p><p><strong>Methods: </strong>This was long-term follow-up of a randomized trial. We enrolled 285 patients aged 60 years or older who were scheduled for elective cardiac surgery. Patients were randomized to receive either dexmedetomidine or placebo (normal saline) during and early after surgery. Follow-up was conducted for up to 6 years post-surgery. The primary endpoint was overall survival. Secondary outcomes included major adverse cardiovascular events (MACE)-free and hospital-free survivals, as well as cognitive function and quality of life in 6-year survivors.</p><p><strong>Results: </strong>All 285 patients were included in final analysis. Median follow-up duration was 80 months (interquartile range 30 to 80). Overall survival did not differ between the two groups: there were 18 deaths (12.6%) with placebo versus 22 deaths (15.5%) with dexmedetomidine; hazard ratio (HR) 1.22, 95% CI 0.65 to 2.27, p = 0.418. MACE-free survival was 23 (16.1%) with placebo versus 24 (16.9%) with dexmedetomidine; HR 1.03, 95% CI 0.58 to 1.83, P = 0.911. Hospital-free survival was 39 (27.3%) with placebo versus 42 (29.6%) with dexmedetomidine; HR 1.04, 95% CI 0.67 to 1.61, P = 0.853. Among 6-year survivors, the scores of cognitive function and quality of life were similar between groups.</p><p><strong>Conclusions: </strong>We found that, for older patients undergoing elective cardiac surgery, dexmedetomidine administered during and early after surgery did not alter overall and MACE-free survivals, as well as long-term cognitive function and quality of life. However, considering the underpowered sample size and non-negligible loss to follow-up rate, our results need further confirmation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT03289325 (September 20, 2017).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"130"},"PeriodicalIF":2.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of remimazolam tosylate and propofol in hemodynamic stability, postoperative cognitive function, and recovery in general anesthesia combined with regional nerve blocks: a retrospective cohort study.","authors":"Jiaman Li, Li Liao, Chunyang Shao, Yifeng Yang, Yan Tang, Qiang Wei, Li Xu","doi":"10.1186/s12871-025-02981-8","DOIUrl":"10.1186/s12871-025-02981-8","url":null,"abstract":"<p><strong>Background: </strong>General anesthesia (GA) combined with regional anesthesia (RA) is commonly used to enhance perioperative analgesia and hemodynamic stability. This study aimed to compare the hemodynamic effects and postoperative cognitive function between remimazolam tosylate and propofol in patients undergoing GA combined with RA.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 4408 patients who underwent elective upper or lower limb surgeries at our institution from January 2020 to June 2024. Patients were divided into two groups: Remimazolam (n = 2391) and Propofol (n = 2017). The primary outcomes included hemodynamic parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], mean arterial pressure [MAP]) and postoperative cognitive function (Montreal Cognitive Assessment [MoCA] scores at 24, 48, and 72 h). Secondary outcomes included anesthetic drug consumption, adverse events, and recovery times.</p><p><strong>Results: </strong>The Remimazolam group was associated with more stable hemodynamic parameters, with significantly higher SBP (121.4 ± 8.3 vs. 112.6 ± 9.2 mmHg, p < 0.05), DBP (72.3 ± 6.1 vs. 67.8 ± 5.9 mmHg, p < 0.05), and MAP (88.3 ± 7.4 vs. 83.1 ± 7.2 mmHg, p < 0.05) compared to the Propofol group. Postoperative cognitive function was superior in the Remimazolam group, with higher MoCA scores at 24, 48, and 72 h (19.6 ± 2.1 vs. 16.3 ± 3.4 at 24 h, p < 0.05). The Remimazolam group also had lower anesthetic consumption (0.16 ± 0.02 vs. 2.4 ± 0.3 mg/kg, p < 0.05), faster recovery times (extubation 8.4 ± 2.1 vs. 11.2 ± 3.4 min, p < 0.05), and fewer adverse events (hypotension: 14% vs. 28%, p < 0.05).</p><p><strong>Conclusion: </strong>Remimazolam tosylate was associated with more stable hemodynamic parameters, lower rates of postoperative cognitive dysfunction, and shorter recovery times compared to propofol in patients undergoing GA combined with RA, suggesting it may be a safer alternative for patients.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"126"},"PeriodicalIF":2.3,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical predictors of extubation failure in postoperative critically ill patients: a post-hoc analysis of a multicenter prospective observational study.","authors":"Jun Hattori, Aiko Tanaka, Junko Kosaka, Osamu Hirao, Nana Furushima, Yuichi Maki, Daijiro Kabata, Akinori Uchiyama, Moritoki Egi, Hiroshi Morimatsu, Satoshi Mizobuchi, Yoshifumi Kotake, Ayumi Shintani, Yukiko Koyama, Takeshi Yoshida, Yuji Fujino","doi":"10.1186/s12871-025-02996-1","DOIUrl":"10.1186/s12871-025-02996-1","url":null,"abstract":"<p><strong>Background: </strong>Postoperative patients constitute majority of critically ill patients, although factors predicting extubation failure in this group of patients remain unidentified. Aiming to propose clinical predictors of reintubation in postoperative patients, we conducted a post-hoc analysis of a multicenter prospective observational study.</p><p><strong>Methods: </strong>This study included postoperative critically ill patients who underwent mechanical ventilation for > 24 h and were extubated after a successful 30-min spontaneous breathing trial. The primary outcome was reintubation within 48 h after extubation, and clinical predictors for reintubation were investigated using logistic regression analyses.</p><p><strong>Results: </strong>Among the 355 included patients, 10.7% required reintubation. Multivariable logistic regression identified that the number of endotracheal suctioning episodes during the 24 h before extubation and underlying respiratory disease or pneumonia occurrence were significantly associated with reintubation (adjusted odds ratio [OR] 1.11, 95% confidence interval [CI] 1.05-1.18, p < 0.001; adjusted OR 2.58, 95%CI 1.30-5.13, p = 0.007). The probability of reintubation was increased significantly with the higher frequency of endotracheal suctioning, as indicated by restricted cubic splines. Subgroup analysis showed that these predictors were consistently associated with reintubation regardless of the use of noninvasive respiratory support after extubation.</p><p><strong>Conclusions: </strong>Endotracheal suctioning frequency and respiratory complications were identified as independent predictors of reintubation. These readily obtainable predictors may aid in decision-making regarding the extubation of postoperative patients.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"127"},"PeriodicalIF":2.3,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated right ventricular systolic pressure and outcomes after emergency hip surgery: a case control study.","authors":"Meghan Carton, David O'Driscoll, Brian Marsh, Sean Gaine, Aisling McMahon","doi":"10.1186/s12871-025-02999-y","DOIUrl":"10.1186/s12871-025-02999-y","url":null,"abstract":"<p><p>Patients at risk of pulmonary hypertension frequently present for emergency orthopedic surgery. A right ventricular systolic pressure of 35 mmHg or above, calculated from a tricuspid regurgitant jet on transthoracic echocardiogram, is considered an appropriate screening test for pulmonary hypertension. The aim of this study was to evaluate the impact of an elevated right ventricular systolic pressure detected on a preoperative transthoracic echocardiogram, on outcomes after emergency hip surgery. We undertook a retrospective, single centre, case control study of 98 adult patients who had a transthoracic echocardiogram before undergoing emergency hip surgery over a six-year period. Forty-two of the 98 patients (43%) had an elevated right ventricular systolic pressure (≥ 35mmHg) and 56 patients (57%) had a normal right ventricular systolic pressure (< 35mmHg) on preoperative echocardiography. All in-hospital deaths in our study occurred in the elevated right ventricular systolic pressure group (8/42 (19%) vs. 0/56 (0%), p = < 0.001). Three patients died within one week of surgery after a cardiac arrest. The remaining 5 patients died a median of 26 (IQR 24-59) days after surgery due to pneumonia and progression of comorbid disease. Patients with an elevated right ventricular systolic pressure were older and had a higher prevalence of atrial fibrillation. In multiple logistic regression analysis, there was no association between either of these variables and survival to hospital discharge. There was a greater number of patients with heart failure, ischaemic heart disease and chronic obstructive pulmonary disease in the elevated right ventricular systolic pressure group, however the differences between the two groups did not reach statistical significance. This study highlights an association between elevated preoperative right ventricular systolic pressure and increased mortality after emergency hip surgery. Elevated right ventricular systolic pressure could be indicative of pulmonary hypertension or be secondary to underlying heart or lung disease. Irrespective of the exact cause of raised right ventricular systolic pressure, the association with increased in hospital mortality warrants further investigation.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"128"},"PeriodicalIF":2.3,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective dose of ciprofol combined with low-dose sufentanil for sedation of gastroscopy: a dose-finding study using a biased coin design.","authors":"Bingwei Hu, Ting Guan, Chenyuan Yu, Danfeng Wang, Qing Wang, Hongwei Wang","doi":"10.1186/s12871-025-02986-3","DOIUrl":"10.1186/s12871-025-02986-3","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to determine the 90% effective dose of ciprofol combined with 5 µg of sufentanil for sedation during gastroscopy.</p><p><strong>Methods: </strong>This was a double-blind, single-center dose-finding study. The ciprofol dose was assigned using a biased coin design according to the response of the previous patient, except for the first one, for which the dose was 0.3 mg/kg. All patients received 5 µg of sufentanil. The criterion for successful sedation was gastroscope insertion without choking, coughing, or body movement. If the sedation of the previous patient was unsuccessful, the dose for the next patient was increased by 0.05 mg/kg; if the sedation of the previous patient was successful, the next dose was reduced by 0.05 mg/kg or remained the same according to the biased coin result. The 90% effective dose was obtained using isotonic regression (the 95% confidence interval was obtained using the bootstrapping method) as the primary method, and the results were obtained using probit regression as a sensitivity analysis.</p><p><strong>Results: </strong>Fifty-three patients were included in this study. Patients were assigned to one of four dose groups using a biased coin toss: group A (0.30 mg/kg), group B (0.35 mg/kg), group C (0.40 mg/kg) or group D (0.45 mg/kg). The 90% effective dose was 0.367 (95% CI: 0.344-0.416) mg/kg according to isotonic regression and 0.368 (95% CI: 0.347-0.419) mg/kg according to probit regression. The differences in the incidence of hypotension, mean arterial pressure and heart rate among the dose groups were not statistically significant. However, there was a statistically significant decrease in the mean arterial pressure and heart rate (P < 0.05) after the administration of ciprofol.</p><p><strong>Conclusion: </strong>The 90% effective dose of ciprofol combined with 5 µg of sufentanil for sedation during gastroscopy was determined to be 0.367 (95% CI: 0.344-0.416) mg/kg. Within the dose range of 0.3-0.45 mg/kg, ciprofol reduced the mean arterial pressure and heart rate in patients, but these effects were not dose-dependent.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"124"},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Negative pressure pulmonary edema resulting from upper airway obstruction during the post-anesthesia recovery period: a case series and literature review.","authors":"Meng Luo, Man Li, Zhijun Qin","doi":"10.1186/s12871-025-02998-z","DOIUrl":"10.1186/s12871-025-02998-z","url":null,"abstract":"<p><strong>Introduction: </strong>Negative pressure pulmonary edema (NPPE) is a non-cardiogenic pulmonary edema primarily resulting from upper airway obstruction, particularly following laryngospasm during the post-anesthesia recovery period.</p><p><strong>Cases presentation: </strong>We report five cases of NPPE that occurred during recovery from general anesthesia at our institution. Among these, four cases were attributed to glossoptosis following extubation, while one case resulted from laryngeal mask displacement. All patients exhibited typical clinical features and imaging findings consistent with pulmonary edema, and none experienced poor prognoses.</p><p><strong>Conclusions: </strong>Glossoptosis and improper positioning of the laryngeal mask during the recovery phase of anesthesia pose a risk for inducing NPPE.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"125"},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the analgesic efficacy of ultrasound-guided superficial serratus anterior plane block and intercostal nerve block for rib fractures: a randomized controlled trial.","authors":"Musa Zengin, Onur Küçük, Muhyettin Aslan, Göktürk Fındık, Ali Alagöz","doi":"10.1186/s12871-025-03000-6","DOIUrl":"10.1186/s12871-025-03000-6","url":null,"abstract":"<p><strong>Background: </strong>Various regional analgesic methods are frequently incorporated into multimodal analgesia strategies for managing rib fractures. This study aimed to compare the analgesic efficacy of ultrasound-guided superficial serratus anterior plane block (S-SAPB) and intercostal nerve block (ICNB) in patients with isolated rib fractures.</p><p><strong>Methods: </strong>This randomized controlled trial included patients aged 18-65 years with unilateral isolated rib fractures (≤ 6 ribs) resulting from trauma. Patients underwent ultrasound-guided S-SAPB (20 ml 0.25% bupivacaine) or ICNB (3 ml 0.25% bupivacaine for each fractured rib). Pain levels were assessed using the Visual Analogue Scale (VAS) both prior to the procedure (Pre-Block, (T0)) and at specific time points following the intervention: 1st hour (T1), 2nd hour (T2), 4th hour (T4), 8th hour (T8), 16th hour (T16), and 24th hour (T24). The changes in observed values over time were expressed as delta (Δ).</p><p><strong>Results: </strong>Both S-SAPB and ICNB provided effective analgesia. In the first 4 h, ICNB demonstrated a greater reduction in VAS scores, particularly in patients with 10^th and 11^th rib fractures. However, S-SAPB resulted in significantly longer-lasting analgesia, with greater pain relief after 8 h (T8-T24) compared to ICNB (p < 0.05). Patients in the S-SAPB group required no additional analgesia, whereas 43.3% of ICNB patients required supplemental tramadol (p < 0.001). Both techniques were well tolerated, with no reported complications.</p><p><strong>Conclusions: </strong>S-SAPB provides prolonged analgesia and may be preferable for managing rib fracture pain beyond the initial 8 h. However, ICNB offers superior pain relief in the early postoperative period, especially for lower rib fractures (10^th-11^th ribs). A combined approach that includes both blocks may optimize pain control in patients with multiple rib fractures involving the 10^th and 11^th ribs.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"122"},"PeriodicalIF":2.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of noninvasive electrical cardiometry and transpulmonary thermodilution for cardiac output measurement in critically ill patients: a prospective observational study.","authors":"Wenliang Song, Jiayan Guo, Daiyin Cao, Jinlong Jiang, Tao Yang, Xiaoxun Ma, Hao Yuan, Jianfeng Wu, Xiangdong Guan, Xiang Si","doi":"10.1186/s12871-025-03005-1","DOIUrl":"10.1186/s12871-025-03005-1","url":null,"abstract":"<p><strong>Background: </strong>Cardiac output (CO) monitoring is essential for diagnosing and managing critically ill patients. Recently, a non-invasive haemodynamic monitoring technique, electrical cardiometry (EC), has gathered increasing interest among ICU physicians. This study aimed to explore the accuracy of CO estimated by non-invasive EC (CO_EC) compared to CO determined by transpulmonary thermodilution (CO_TPTD) and to evaluate the ability of CO_EC to track CO_TPTD changes (ΔCO_TPTD).</p><p><strong>Methods: </strong>This prospective, observational, single-center study was conducted from April 2021 to April 2023, involving patients who required haemodynamic monitoring using a transpulmonary thermodilution device (PiCCO). CO_TPTD and CO_EC were recorded simultaneously, with the investigators obtaining the CO_EC measurements were blinded to the CO_TPTD results and vice versa. Agreement between the methods was evaluated using Bland-Altman analysis and percentage error (PE). The ability of CO_EC to track changes in CO_TPTD was examined using four-quadrant and polar plots.</p><p><strong>Results: </strong>Seventy-two patients with PiCCO haemodynamic monitoring were included, yielding 285 paired CO measurements. The bias between CO_EC and CO_TPTD was 0.47 L/min, with a limit of agreement (LoA) ranging from -2.91 to 3.85 L/min and a PE of 54.0%. Among 212 pairs of ΔCO data, excluding a central zone of 15% in the four-quadrant plot, the concordance rate between ΔCO_EC % and ΔCO_TPTD % was 70%. In the polar plot, excluding a central zone with a radius of 0.625 L/min (10% of the mean CO_TPTD), the mean polar angle for ΔCO_EC was 2.2°, with a radial LoA of 56.0°. Exploratory subgroup analysis indicated a PE of 47.0% between CO_EC and CO_TPTD and a concordance rate of 72% between ΔCO_EC% and ΔCO_TPTD% in patients with normal CO (CO ≥ 4 L/min). In patients with elevated thoracic fluid content (TFC > 35 kΩ), the PE between CO_EC and CO_TPTD was 45.0%, with a concordance rate of 64% between ΔCO_EC% and ΔCO_TPTD%. Additionally, in patients receiving low-dose norepinephrine equivalents (NEE ≤ 0.25 μg/kg/min), CO_EC and CO_TPTD exhibited a PE of 45.0%, while ΔCO_EC% and ΔCO_TPTD% achieved a concordance rate of 75% and a radial LoA of 44.2°.</p><p><strong>Conclusion: </strong>In critically ill patients, non-invasive EC indicated limited accuracy in measuring CO, along with a restricted ability to reliably track CO changes. These findings suggested that EC may not be interchangeable with TPTD in the general ICU population.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"123"},"PeriodicalIF":2.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total bilirubin as a marker for hemolysis and outcome in patients with severe ARDS treated with veno-venous ECMO.","authors":"Victoria Bünger, Mario Menk, Oliver Hunsicker, Alexander Krannich, Felix Balzer, Claudia D Spies, Wolfgang M Kuebler, Steffen Weber-Carstens, Jan A Graw","doi":"10.1186/s12871-025-02988-1","DOIUrl":"10.1186/s12871-025-02988-1","url":null,"abstract":"<p><strong>Background: </strong>Hemolysis is a common complication in critically ill patients with sepsis, acute respiratory distress syndrome (ARDS) or therapy with extracorporeal membrane oxygenation (ECMO). Heme degradation product bilirubin might accumulate in conditions of significant hemolysis. In patients with ARDS and therapy with veno-venous ECMO (vvECMO), the prognostic potential of elevated initial total bilirubin (tBili) was investigated.</p><p><strong>Methods: </strong>Retrospective analysis of patients with ARDS and vvECMO-therapy (n = 327) admitted to a tertiary ARDS center. A tBili cut-off value was determined by binary recursive partitioning. Baseline characteristics were compared and relevant variables were included in a multivariate logistic regression model with backward variable selection. Primary endpoint was survival within 28 days analyzed with Kaplan-Meier-curves and cox regression. Secondary endpoints included failure free composites for organ dysfunction, renal replacement therapy (RRT), vasopressor therapy and ECMO within 28 days and were compared using competing risk regression analysis.</p><p><strong>Results: </strong>A cut-off value of 3.6mg/dl divided the cohort for ICU mortality (tBili ≤ 3.6mg/dl: 46% (n = 273) vs. tBili > 3.6mg/dl: 78% (n = 54), p < 0.001). The group with tBili > 3.6mg/dl showed a higher 28-day mortality (HR 3.03 [95%CI 2.07-4.43], p < 0.001) and significantly lower chances of successful recovery from organ dysfunction (subdistribution hazard ratio (SHR) 0.29 [0.13-0.66], p < 0.001), RRT (SHR 0.34 [0.14-0.85], p = 0.02), and ECMO (SHR 0.46 [0.25-0.86], p = 0.015) compared to the group with tBili ≤ 3.6mg/dl. Recovery from vasopressor therapy did not differ between groups (SHR 0.63 [0.32-1.24], p = 0.18).</p><p><strong>Conclusion: </strong>Patients with ARDS, vvECMO-therapy and tBili > 3.6mg/dl had a higher mortality and lower chances for recovery from organ dysfunction, RRT, and ECMO within 28 days. The tBili-cut-off value may be useful to identify patients at risk for unfavorable outcomes.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"121"},"PeriodicalIF":2.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the effectiveness of two different concentrations of ropivacaine for intrapleural analgesia in reducing stimulatory pain caused by chest tubes after uniportal video-assisted thoracoscopic surgery: a randomised controlled study.","authors":"Wenjing Tang, Yonggang Hao, Gangming Wu, Haixia Wang","doi":"10.1186/s12871-025-02992-5","DOIUrl":"10.1186/s12871-025-02992-5","url":null,"abstract":"<p><strong>Background: </strong>Pain caused by chest tube placed after uniportal video-assisted thoracoscopic surgery (UVATS) is often neglected. Ropivacaine can be used to alleviate pain related to the chest tube, but the current lowest effective concentration of ropivacaine remains unclear.</p><p><strong>Methods: </strong>To investigate the analgesic effect of administering two different concentrations of ropivacaine into the pleural cavity via pleural drainage tube bypass after UVATS. Ninety patients were randomly divided into three groups: Control group (PCIA only), Low-dose group (PCIA combined with intrathoracic infusion of 200 ml 0.25% ropivacaine), Medium-dose group (PCIA combined with intrathoracic infusion of 200 ml 0.5% ropivacaine). The analysis included Visual Analogue Scale (VAS) scores for chest tube-related pain and surgical incision pain at 6 h, 12 h, 24 h, and 48 h post-operation for each group. Compare incidence of adverse reactions (respiratory depression, hypotension, nausea/vomiting, arrhythmia, dizziness) within 48 h.</p><p><strong>Results: </strong>Compared to the control group, both 0.25% and 0.50% ropivacaine effectively reduced chest tube-related pain (P < 0.001) and surgical incision pain (P < 0.001) at 6 h, 12 h, 24 h, and 48 h postoperatively. However, no significant differences were observed between the two concentrations of ropivacaine in alleviating rest and cough pain related to the chest tube (P > 0.05) or surgical incision (P > 0.05) within 48 h postoperatively. Adverse reaction rates were similar among groups within 48 h postoperatively (P = 0.383).</p><p><strong>Conclusion: </strong>The analgesic effect of ropivacaine infusion with concentrations of 0.25% and 0.50% administered via intrathoracic pumps for chest tube-related pain after UVATS showed no significant difference, but both were superior to the sole use of PCIA.</p><p><strong>Registration: </strong>Chinese Clinical Trial Registry ChiCTR2200065184.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"119"},"PeriodicalIF":2.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}